Relevance of Military Trauma Care to Civilian Trauma Practice
Mary Langcake
Outline THE RELEVANCE OF
MILITARY TRAUMA CARE
TO CIVILIAN PRATICE
Mary Langcake FRACS
SQNLDR RAAFSR
Director of Trauma
St George Hospital
Sydney Australia
Dulce bellum inexpertis
Erasmus
OBJECTIVES
* History
* Innovations from recent conflicts
* Is it relevant to civilian practice?
* The future
HISTORY
* Ancient Greece had organised trauma systems
* The Iliad - first description of treatment of battlefield wounds (700BC)
* Roman valetudinaria are considered by some as precursor of military hospitals
- clean
- located near running water
- isolation for infection
* Principles were adopted by civilians
- first public health measures
HISTORY
* Pare's - treatment of war wounds in the 16thC
- arterial ligation
- wound dressing
- abandoned cautery
- knowledge of anatomy
HISTORY
* Baron Larrey
* US Civil War
INNOVATIONS FROM RECENT CONFLICTS
* Desert Storm 1 - most preventable deaths on the battlefield due to haemorrhage
- subsequent emphasis on control of bleeding
* Iraq and Afghanistan
- damage control resuscitation
- concept of permissive hypotension
- minimal fluids
- massive transfusion protocol
- novel haemostatic agents
- critical care evacuation
IS IT RELEVANT TO CIVILIAN PRACTICE?
IS IT RELEVANT TO CIVILIAN PRACTICE?
"The attacks of July 2005 in London and the resulting clinical experiences
described illustrate how blast and ballistic injury are a reality for today's
National Health Service..........
Inner city gunshot wounds and increasingly prevalent knife injuries present
prehospital and hospital personnel with casualties who may benefit from current
military haemorrhage protocols or adaptations of those....."
Col T J Hodgetts et al 2006
IS IT RELEVANT TO CIVILIAN PRACTICE?
* Severely injured patients benefit from approaches to care developed over
centuries of military trauma care
* With the rise of global terrorism civilian emergency care providers face
increasing likelihood of attending to trauma far outside of normal scope of
practice
THE FUTURE
* Imperative that the lessons learned caring for critically injured service
personnel and civilians caught in conflict are not ignored
* We cannot save them all but must strive to be the best we can in their memory
In Memoriam
|
Ministry of Health
